Paediatrics Lecture 1 Flashcards
Which three areas does a paediatric feeding assessment consist of?
- Assessment considerations
- Clinical examination
- Instrumental assessment
What are assessment considerations?
Referral information (age, diagnosis, medical history, current weight, primary concerns) Environment - where will the assessment take place Tools - what equipment do you need? Food, thickener, torch, gloves, tongue depressor etc. Preassessment case history - food diary (start/finish time, who fed, amount eaten, behaviours), video of mealtime, "always sometimes never" food lists, parent goals/concerns
What does the clinical examination consist of?
- Case history (birth, medical, daily intake, feeding history, mealtime setup)
- Oromotor assessment
- Oral trials/observations
OME: General observations
- Facial symmetry at rest and when smiling
- Posture (is he/she “floppy”?)
- Weight (nourishment?)
- Breathing - quiet/effortful/wheezing
- Mouth or nose breather?
- State - agitated/distressed?
OME: Oral anatomy
- Look into baby’s mouth for size and shape of tongue in relation to the oral cavity (any indication of oral thrush?)
- Lift baby’s tongue. Observe the range of movement and whether the frenulum is strongly holding tongue to floor of mouth
OME: Reflexes
Rooting
Protrusion
Sucking
Eating is a REFLEXIVE process in infants
OME: Suck swallow breathe. How do we assess? What should we look for?
Milk feed = best opportunity to assess.
- Do baby’s lips form a tight seal around the nipple/teat?
- Does milk eject from the mouth during swallowing?
- Are swallows audible? Loud/gurgly?
- Does baby breathe comfortably between swallows?
- Can baby pause between suck bursts without losing attachment?
- Changes in breathing from pre- to post-feed
Oral trials: What do we look for?
Positioning Equipment Fluid/food consistency/texture Who is feeding? Rate of feeding Amount taken Oral movements (lips, tongue, jaw) Swallow Signs of aspiration State (calm, alert, drowsy etc.) Behaviour (of child and carer) Reason for feed finishing
What should we look out for during Cervical Auscultation?
- Oral transit time
- Delay of swallow trigger
- Range of laryngeal elevation
- Describe swallow sound (coordinated?)
- Cough quality/timing/strength
Signs of aspiration in paediatric clients
- Recurrent chest infections
- Choking/coughing during swallowing
- Wet/gurgly voice quality post-swallow
- Breath changes
- Facial colour changes
- Signs of distress
Which three areas does a paediatric feeding intervention consist of?
- Therapy
- Service delivery
- Ongoing education and support
What may paediatric feeding therapy consist of?
Oral motor treatment Behavioural interventions Pacing Positioning Diet modification Equipment/utensils Environmental modifications Alternative feeding
Basic intervention principles: Paediatric feeding
- Every child and family is INDIVIDUAL
- Developmental approach (based on normal development of feeding)
- Child-centred treatment (cooperative)
- Developing AUTONOMY at mealtimes for the child
- Children learn through PLAY
What intervention is available for breathing-swallowing coordination?
- Positioning - keep child still with trunk supported
- Equipment - flow rate of milk (dependent on teat)
- Pacing - providing baby with breaks between swallows
- Limit fatigue - limite feeding time to 20-30 minutes
What intervention is available for positioning?
- Being swaddled
- Support trunk/midline
- Feet supported
- Chin tuck
Which three areas of intervention are available for oral motor coordination?
Oral phase:
- Equipment (bottles/teats/cup)
- Modified textures (bite and dissolve, puree, soft cubes) - how quickly does the bolus move once it is in the mouth?
- Bolus size (control)
What ways can we treat sucking?
- “Suck training” dummy work (tug of war)
- Adapt teat (softer, wider, narrower)
- Toys
- Baby toothbrushes
- Slow down milk flow but make it easier to extract
How can we manage/treat oral motor coordination?
Practice tongue tip lateralisation Using molars to chew Develop bite strength Develop chewing stamina Lip closure Bite size
How can we practice tongue lateralisation?
- Demonstrate to child
- Place food off to the side
- Use stick shaped foods
- Competition - hold food inside one cheek with tongue
- Use hard mouthing foods
- Practice silly faces in the mirror
How can we practice bite size?
Talk about mouse bites v kid bites v dinosaur bites
How can we practice bite strength?
Theratubing
Foods that make noise
Practic breaking foods with hands first
How can we practice chewing with molars?
Talk about front and back teeths (with model) Squash foods with fingers and then hands Use a mirror Tooth brushing Chew with mouth open Use fingers to assist placement
